Wilk: Sorrentino's Canadian Textbook for the Support Worker, 5th Edition

Chapter 37: Mental Health Disorders

Chapter 37

Mental Health Disorders

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 1

Mental Health and Mental Health

Disorders (1 of 7)
 Mental health disorders can affect all
dimensions of a person’s life: physical,
emotional, spiritual, social, and intellectual.
 Clients may have physical and mental health
challenges.
 Some clients’ physical conditions can result from
mental health challenges, or the reverse.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 2

Mental Health and Mental Health

Disorders (2 of 7)
 DIPPS
 Remember DIPPS when providing support to a
client who has a mental health disorder.
• See textbook box: Providing Compassionate Care:
Supporting Clients With Mental Health Disorders
• Because your clients may have been exposed to
negative attitudes (stigma) in the past, your attitude
toward them is particularly important.
• Pay special attention to your verbal and body language.
• Support workers must understand and be aware of their
attitudes towards mental health and mental illness.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 3

Copyright © 2022 Elsevier, Inc. All rights reserved. 1

Mental Health and Mental Health
Disorders (3 of 7)
 Mental health disorders can be caused by a
combination genetic, biological, personality,
and environmental factors.
 Mental health disorders cause a disturbance
in a person’s ability to cope with or adjust to
stress.
 A person’s thinking, mood, and behaviours are
affected and functioning is impaired.
 1 in 5 Canadians will personally experience a
mental health disorder during their lifetime.
Copyright © 2022 Elsevier, Inc. All Rights Reserved. 4

Mental Health and Mental Health

Disorders (4 of 7)
 Mental health disorders affect people of all
ages, cultures, and educational and income
levels.
 Onset of most mental health disorders occurs
during adolescence or young adulthood.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 5

Mental Health and Mental Health

Disorders (5 of 7)
 The terms mental illness, mental disorder,
emotional illness, and psychiatric disorder all
refer to mental health disorder.

 Mental health is a state of mind in which a

person copes with and adjusts to the
stressors of everyday living in socially
acceptable ways.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 6

Copyright © 2022 Elsevier, Inc. All rights reserved. 2

 Impact of Mental Health
Disorders (6 of 7)
 Over 1 million Canadians currently live with
severe or persistent mental health disorders.
 20% of Canadians will personally experience a
mental health disorder during their lifetime.
 Schizophrenia affects 1% of the population.
 Anxiety disorders affect 5% of the population.
 About 8% of adults in Canada will experience a
major depressive disorder in their lifetime.
 Suicide rates in some Indigenous communities are
among the highest in the world.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 7

Impact of Mental Health

Disorders (7 of 7)
 COVID-19 has impacted all Canadians.
 The CMHA (Canadian Mental Health Association)
stated that the pandemic is continuing to cause
mental health concerns—particularly among
isolated individuals and older persons.
 Mental illness currently costs the economy at
least $50 billion.
 If nothing changes by 2041, there will be over
8.9 million Canadians living with mental
illness.
Copyright © 2022 Elsevier, Inc. All Rights Reserved. 8

Causes of Mental Health

Disorders
 Causes of mental health disorders include:
 Biological factors
 Childhood experiences
 Social and cultural factors
 Stressful life events
 Poor physical health of disability

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 9

Copyright © 2022 Elsevier, Inc. All rights reserved. 3

 Supporting Clients and Their
Families (1 of 4)
 Until the 1960s, those with chronic or severe
mental health disorders lived in psychiatric
facilities.
 Now only those who are severely ill live in
facilities.
 Some with mental health disorders end up
living on the streets
 They may be too ill to hold a job or apply for
financial assistance.
 They may fear receiving treatment.
 They may not be aware of their own illness.
Copyright © 2022 Elsevier, Inc. All Rights Reserved. 10

Supporting Clients and Their

Families (2 of 4)
 Most people with mental health disorders:
 Are able to live in the community
 May live in their own home, group homes, or in
assisted-living facilities
 Support workers provide valuable care and
support to clients and their families in a wide
variety of settings.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 11

Supporting Clients and Their

Families (3 of 4)
 Team Approach
 Physical safety and emotional needs are
addressed in the care-planning process.
• This requires input from various members of the health
care team.
• Health care team includes family physician, nurse,
occupational therapist, social worker, support worker,
psychiatrists, psychologists and psychotherapists,
Indigenous mental health providers.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 12

Copyright © 2022 Elsevier, Inc. All rights reserved. 4

 Supporting Clients and Their
Families (4 of 4)
 Treatment of Mental Health Disorders
 Often involves psychotherapy. Various forms
include:
• Psychoanalysis
• Behaviour therapy
• Cognitive behavioural therapy
• Group therapy
• Family therapy

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 13

Stigma of Mental Health

Disorders (1 of 3)
 Those with mental health disorders are often
discriminated against because people lack
understanding about mental illness.
 Some blame people with the illness for their own
difficulties.
 Some believe that a person with a mental health
disorder is dangerous.
 Such attitudes lead people to avoid and exclude
those with an illness—which causes them to feel
ashamed, rejected, and isolated.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 14

Stigma of Mental Health

Disorders (2 of 3)
 Stigma is shame or social disgrace associated
with a circumstance, quality, or person.
 Stigma affects men more than women.
 Extends to the workplace, although it is against
human rights legislation to discriminate against
people who have mental health disorders.
 The main goal of the Canadian Alliance on
Mental Illness and Mental Health (CAMIMH) is
to prevent stigma and discrimination.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 15

Copyright © 2022 Elsevier, Inc. All rights reserved. 5

 Stigma of Mental Health
Disorders (3 of 3)
 Effect on the Family:
 Family members make difficult decisions about
care, treatment, and housing.
 Some may face a financial burden.
 Some may feel guilty and blame themselves for
the illness.
 Family members are at risk for depression.
 Family members are also affected by the stigma of
mental health disorders.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 16

Culture and Its Influence on

Mental Health Disorders and
Treatment (1 of 4)
 Culture influences a person’s understanding
of mental health disorders.
 Clients in some cultures may find it difficult to seek
medical attention for their mental health disorders.
 Some family members may refuse to accept
mental health diagnoses.
 Interpretation of signs or symptoms of what some
call mental health disorders varies from culture to
culture—what is considered appropriate in one
culture may be inappropriate in another.
Copyright © 2022 Elsevier, Inc. All Rights Reserved. 17

Culture and Its Influence on

Mental Health Disorders and
Treatment (2 of 4)
 Mental health challenges among
marginalized populations within Canada
include the following:
 Not being fluent in an official language (and
therefore being less likely to seek support)
 Belonging to a visible-minority group
 Being geographically isolated

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 18

Copyright © 2022 Elsevier, Inc. All rights reserved. 6

 Culture and Its Influence on
Mental Health Disorders and
Treatment (3 of 4)
 Mental health challenges among
marginalized populations within Canada
include the following:
 Living with a physical or intellectual disability
 Living with a mental health disorder
 Having or had a substance abuse problem
 Working in the sex trade

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 19

Culture and Its Influence on

Mental Health Disorders and
Treatment (4 of 4)
 Marginalized people also include prison
inmates and refugees.
 Many refugees have seen or experienced
imprisonment, torture, murder of loved ones,
extreme hunger, and poverty.
 Many marginalized people have a higher
incidence of depression, anxiety, and stress.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 20

Slide 20

Acquired Brain Injuries (ABI)

 Are any type of sudden injury that causes
temporary or permanent damage to the brain.
 Clients who live with an ABI may also be at
increased risk for feelings of frustration,
anxiety, mood swings, or depression.
 Families of clients must learn to adjust to
changes in personality or potential loss of
income due to client’s inability to work.
 See textbook box: Supporting Greg Wood: How
an ABI Can Affect Behaviour
Copyright © 2022 Elsevier, Inc. All Rights Reserved. 21

Copyright © 2022 Elsevier, Inc. All rights reserved. 7

Supporting Clients With Acquired
Brain Injury (ABI)
 Support workers must keep the following in
mind:
 Follow the care plan; reassure the client that what
they are experiencing is a result of the brain injury.
 Encourage the client to establish daily routines and
structure.
 Encourage the client to set both short-term and long-
term goals.
 Ensure clients’ adaptive devices are within reach.
 Encourage clients to “put the past behind them”.
 Observe for and report signs of any substance abuse.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 22

Anxiety Disorders
 Anxiety is a vague, uneasy feeling in
response to stress.
 People with anxiety experience disproportionate
fears and worries.
 Affects 5% of the Canadian population.
 Onset typically begins in childhood
• Women are twice as likely as men to experience it.
 Some anxiety is normal.
• However, clients with mental health disorders experience
extreme anxiety.
• Many anxiety disorders can be treated with medication.
Copyright © 2022 Elsevier, Inc. All Rights Reserved. 23

Supporting Clients With Anxiety

Disorders
 Avoid situations that are known to cause
anxiety for the client.
 Avoid discussing subjects that cause anxiety.
 Provide comfort during periods of anxiety.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 24

Copyright © 2022 Elsevier, Inc. All rights reserved. 8

 Panic Disorder (1 of 3)
 An intense and sudden feeling of fear,
anxiety, terror, or dread for no obvious
reason.
 Physical symptoms of fear—shortness of breath,
racing heart, sweat—can escalate quickly.
 Many people experience symptoms that are
similar to those of a heart attack.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 25

Panic Disorder (2 of 3)
 Panic attacks can happen anytime, anywhere
without warning.
 Clients with panic attacks may live in fear of
the next attack.
 Some are unable to leave their homes.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 26

Panic Disorder (3 of 3)
 It is more common in women than men.
 Usually starts in young adulthood, often
during times of excessive stress.
 This disorder can last for months or years.
 Treatment includes:
 Teaching the client to recognize and change
thinking patterns before they lead to panic attack
 Medication

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 27

Copyright © 2022 Elsevier, Inc. All rights reserved. 9

 Phobic Disorder (1 of 2)
 Phobia means fear, panic, or dread.
 It is an intense fear of a particular thing or situation.
 Clients who struggle with phobias often feel
embarrassed and stupid.
 Common phobias:
 Agoraphobia: the fear of open, crowded, public
places
 Claustrophobia: the fear of small, enclosed places

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 28

Slide 28

Phobic Disorder (2 of 2)
 Symptoms of phobic disorder:
 Excessive worry
 Sleep disruption from worrying
 Fatigue or irritability
 Difficulty concentrating
 Physical symptoms such as increased sweating,
heavy breathing, irregular heartbeats
(palpitations), dizziness, faintness, muscle pain or
tension, and even diarrhea from interference with
digestion

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 29

Slide 29

Other Types of Anxiety Disorders

 Separation anxiety disorders
 Persistent and excessive worrying about losing
major attachment figures
 Selective mutism
 Lasts for a month or more, where the client
experiences a consistent inability to speak in
social situations
 Social anxiety
 Severe distress in social situations

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 30

Copyright © 2022 Elsevier, Inc. All rights reserved. 10

 Trauma and Stressor-Related
Disorders
 These are anxiety disorders that can develop
after an individual has experienced or
witnessed a major trauma.
 One example is post-traumatic stress
disorder (PTSD)
 Can occur in people of all ages, ethnicities,
cultures, and genders

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 31

Post-Traumatic Stress Disorder

(PTSD) (1 of 3)
 Signs and symptoms include:
 Vivid nightmares of traumatic event(s)
 Feeling of nervousness, edginess
 Avoidance of triggers that recall memories of
traumatic event
 Difficulty concentrating or sleeping
 Feelings of loss of control

• See textbook box: Supporting Mr. Awondo: How Past

Traumatic Events Can Be Triggers

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 32

Post-Traumatic Stress Disorder

(PTSD) (2 of 3)
 PTSD symptoms fall into 3 categories (those
who have PTSD will have at least one
symptom per category):
 Reliving or re-experiencing the trauma
 Attempts to avoid thoughts, situations, or people
that are reminders of the trauma
 Increased anxiety or arousal, being constantly on
guard for danger, being easily startled

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 33

Copyright © 2022 Elsevier, Inc. All rights reserved. 11

 Post-Traumatic Stress Disorder
(PTSD) (3 of 3)
 Survivors with PTSD are more likely to
experience substance abuse, phobias,
chronic pain, poor concentration, sleep
disturbances, extreme anxiety, overwhelming
guilt, and are easily angered.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 34

Post-Traumatic Stress Disorder

in Children and Older Persons
 Children who have experienced trauma may
develop different fears (e.g., dark,
stomachache, fear of being alone, etc.)
 May not talk to parents about their fears
 Older persons experience the same
symptoms as children.
 Extreme changes in an older person’s life may
trigger PTSD symptoms (e.g., death of family
member or friend, loss of daily social contact,
feelings of no control when receiving care).

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 35

Supporting Clients With Post-

Traumatic Stress Disorder
 Always treat client according to DIPPS
principles.
 Clients should be given the opportunity to talk
to reminisce about their experiences.
 Clients may have witnessed traumatic events
in their past; they can be triggered at any
time.
 Be aware of changes in client’s willingness to
complete ADLs.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 36

Copyright © 2022 Elsevier, Inc. All rights reserved. 12

 Bipolar and Related Disorders
(1 of 8)
 Also known as manic-depressive illness
 A group of related brain disorders that cause
unusual shifts in a person’s mood, energy,
and ability to function.
 This is considered a long-term illness.
 1% of Canadians will experience this
disorder.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 37

Bipolar and Related Disorders

(2 of 8)
 A person with bipolar disorder has depression
(emotional lows) and mania (emotional highs)
 These behaviours can result in damaged
relationships, poor school or work performance,
even suicide.
 A manic episode is diagnosed if elevated mood
occurs with three or more other symptoms of
mania most of the day, nearly every day, for 1
week or longer.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 38

Bipolar and Related Disorders

(3 of 8)
 Condition is treatable, but this is a recurring
illness.
 Clients need long-term preventative treatment.
 Bipolar disorder tends to run in families.
 Bipolar disorder in children and adolescents
can be hard to distinguish from other issues
they may be experiencing.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 39

Copyright © 2022 Elsevier, Inc. All rights reserved. 13

 Bipolar and Related Disorders
(4 of 8)
 Symptoms of bipolar disorder occur in three
phases:
 Acute phase, when symptoms are escalating
 Continuation phase, when the symptoms are
visible and the client is usually being treated
 Maintenance phase, when the client’s acute
symptoms have subsided
 All mood changes must be reported to the doctor
immediately.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 40

Slide 40

Bipolar and Related Disorders

(5 of 8)
 Signs and symptoms of mania:
 Typically develops in late adolescence
 Symptoms range from mild to severe:
• Increased energy, activity, and restlessness
• Excessive “high”; overly good, euphoric mood
• Extreme irritability
• Racing thoughts and very fast talking; jumping from one
idea to another
• Distractibility; inability to concentrate
• Little need for sleep
• Unrealistic beliefs in one’s abilities and powers
• Poor judgement
Copyright © 2022 Elsevier, Inc. All Rights Reserved. 41

Bipolar and Related Disorders

(6 of 8)
 Signs and symptoms of mania:
• Spending sprees
• A prolonged period of behaviour that is different from
usual
• Increased libido (sex drive)
• Abuse of drugs, particularly cocaine, alcohol, and sleep
medications
• Provocative, intrusive, or aggressive behaviour
• Denial that anything is wrong

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 42

Copyright © 2022 Elsevier, Inc. All rights reserved. 14

 Bipolar and Related Disorders
(7 of 8)
 Supporting clients with bipolar disorder:
 The support worker can assist in keeping a chart
of daily mood symptoms, treatments, sleep
patterns, and life events.
• See textbook Table 37.1: Phases of Treatment of
Bipolar and Related Disorders and the Role of the
Support Worker

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 43

Bipolar and Related Disorders

(8 of 8)
 Supporting clients with bipolar disorder:
 During depression
• Follow the guidelines for major depression (see next
section).
 During manic period
• Provide a calm environment.
• Encourage rest.
• Encourage self-care; assist when needed.
• Do not argue with the client.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 44

Major Depressive Disorder

(1 of 6)
 This is a group of disorders in which the client
has sad, empty, or irritable moods
accompanied by physical changes and
thought changes that are severe enough to
affect their ability to function.
 Associated with severe feelings of worthlessness,
self-blame, sadness, disappointment, and
emptiness that last weeks.
 Interferes with activities of daily living (ADLs).
 Clients may think about or attempt suicide.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 45

Copyright © 2022 Elsevier, Inc. All rights reserved. 15

 Major Depressive Disorder
(2 of 6)
 Treatment is any one or a combination of:
 Psychotherapy
 Medication therapy
 Electroconvulsive therapy (ECT)

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 46

Major Depressive Disorder

(3 of 6)
 Depression is common among older persons.
 Grief is normal.
• After the loss of a loved one, a person may experience
loss and sadness; this is referred to as reactive
depression (not a major depressive disorder).
 80% of people with major depressive disorder who
receive medical intervention can get back to
regular activities.
• See textbook Box 37.3: Signs and Symptoms of
Depression

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 47

Slide 47

Major Depressive Disorder

(4 of 6)
 Factors that trigger depression in older
persons:
 Loneliness
 Loss of family member, friend, partner, pet
 Poor nutrition
 Overuse, underuse, or misuse of prescribed
medications
 Adverse effects of some medications
 Loss of control over finances
 Memory impairment

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 48

Copyright © 2022 Elsevier, Inc. All rights reserved. 16

 Major Depressive Disorder
(5 of 6)
 Reducing Depression in Older Persons
 Depression is often overlooked or misdiagnosed in
older persons.
 Many older persons will not admit to feeling
depressed but will instead become agitated,
irritable, and complain of aches and pains.
 Ways to reduce likelihood of depression in older
persons include:
 Ensure basic needs are met (food, water, etc.)
 Ensure the client has regular medical check-ups

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 49

Slide 49

Major Depressive Disorder

(6 of 6)
 Reducing Depression in Older Persons:
• Provide support and encouraging involvement with
others.
• Provide opportunities for physical activity.
• Provide opportunities to be outside in the fresh air and
sunlight.
• Provide opportunities to interact with pets.
• Provide opportunities for stimulation of the senses.
• Provide opportunities to interact with reminiscence
groups.
• Provide situations that allow the client to feel wanted or
needed.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 50

Seasonal Affective Disorder

(SAD)
 SAD is a type of depression that occurs each
year at the same time.
 Usually starts in fall or winter and ends in spring or
early summer.
 Is more common in colder regions

 Signs and symptoms range from mild to

severe (can be mistaken for major depressive
disorder).
 Treatment for SAD is phototherapy.
• Involves exposure to light from a box containing white
fluorescent light tubes.
Copyright © 2022 Elsevier, Inc. All Rights Reserved. 51

Copyright © 2022 Elsevier, Inc. All rights reserved. 17

 Other Types of Depressive
Disorders
 Include:
 Disruptive mood dysregulation disorder (DMDD)
 Persistent depressive disorder
 Premenstrual dysphoric disorder
 Substance/medication-induced depressive
disorder

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 52

Supporting Clients With a

Depressive Disorder (1 of 2)
 Show that you enjoy being with the client.
 Be aware that most clients aren’t aware they
are depressed.
 Do no minimize client’s moods.
 Be positive.
 Encourage rest.
 Encourage proper nutrition.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 53

Supporting Clients With a

Depressive Disorder (2 of 2)
 Encourage activity and social interactions.
 Be alert for warning signals of suicidal intent.
 See textbook Box 37.4: Warning Signs of Suicidal
Intent
 Provide safe, secure, stable environment.
 Follow care plan.
 Ensure safety.
 Encourage normal activities.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 54

Copyright © 2022 Elsevier, Inc. All rights reserved. 18

 Disruptive, Impulse-Control and
Conduct Disorders (1 of 8)
 These disorders relate to difficult, disruptive,
aggressive, or antisocial behaviours.
 Behaviours associated with physical or verbal
injury to self, others, or objects, or violating the
rights of others.
 Behaviour can be defensive, premeditated, or
impulsive.
 Grouped into 3 types:
• Angry/irritable mood
• Argumentative/defiant behaviour
• Vindictiveness
Copyright © 2022 Elsevier, Inc. All Rights Reserved. 55

Disruptive, Impulse-Control and

Conduct Disorders (2 of 8)
 Oppositional Defiant Disorder (ODD)
 People with this disorder repeatedly engage in
pattern of defiant, disobedient, and hostile
behaviour toward authority figures
 Begins in childhood.
 Goes beyond acceptable misbehaviour for the
child’s age.
 Continues for at least 6 months.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 56

Slide 56

Disruptive, Impulse-Control and

Conduct Disorders (3 of 8)
 Symptoms of ODD in clients:
 Resistance to or stubbornness towards taking
direction form others
 Few or no friends
 Unwillingness to compromise
 Frequent anger or restfulness
 Frequent cruel or revenge-seeking behaviours
 Frequent arguments/challenges authority

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 57

Copyright © 2022 Elsevier, Inc. All rights reserved. 19

 Disruptive, Impulse-Control and
Conduct Disorders (4 of 8)
 Symptoms of ODD in clients:
 Irritable, resentful, or negative attitude
 Provoking others, which comes across as mean,
spiteful, or rude behaviours
 Displaying temper tantrums or outbursts
 Blaming others; denying responsibility
 Repeated trouble at school

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 58

Disruptive, Impulse-Control and

Conduct Disorders (5 of 8)
 Intermittent Explosive Disorder
 Involves recurrent behavioural outbursts,
indicating a failure to control aggressive impulses.
 Outbursts may be physical or verbal.
 The anger is caused by inability to cope mentally
with a situation.
 These outbursts usually have social, financial, or
legal consequences.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 59

Disruptive, Impulse-Control and

Conduct Disorders (6 of 8)
 Symptoms of Intermittent Explosive Disorder:
 Intentional behaviours that cause physical or
emotional harm to others
 Frequent impulsive actions
 Frequent irritability
 Frequent outbursts of anger
 Attempts to provoke others or retaliate against
behaviours of others

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 60

Copyright © 2022 Elsevier, Inc. All rights reserved. 20

 Disruptive, Impulse-Control and
Conduct Disorders (7 of 8)
 Conduct Disorder
 People repeatedly violate the personal or property
rights of others and society
 Usually begins in childhood with lying and
shoplifting and then progresses to more severe
behaviours (e.g., burglary, auto theft)
 Several causes, including severe family
dysfunction

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 61

Disruptive, Impulse-Control and

Conduct Disorders (8 of 8)
 Conduct Disorder:
 Symptoms include:
• Bullying
• Threatening others
• Antisocial behaviours
• Starting fights, using weapons or tools, using physical
violence
• Physical cruelty to animals or people
• stealing from others; destruction of property
• Manipulating
• Repeatedly running away from home
• Abusing alcohol and drugs
Copyright © 2022 Elsevier, Inc. All Rights Reserved. 62

Supporting Clients With

Disruptive, Impulse-Control, and
Conduct Disorders
 Remember the following:
• Accept clients in a nonjudgemental, caring way.
• Maintain a safe distance.
• Keep an open pathway to an exit.
• Avoid doing anything that might escalate situation.
• Try to understand the client’s anger in the cultural
context.
• Remain calm and professional.
• Ensure your safety and the safety of others.
• Encourage the client to find new ways to think about a
situation.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 63

Copyright © 2022 Elsevier, Inc. All rights reserved. 21

 Feeding And Eating Disorders
(1 of 13)
 These disorders arise from altered body image
perceptions.
 Lead to disturbances in eating behaviours and
abnormal concern about body weight and shape.
 They occur mainly in teenage girls and young
women.
 Are influenced by, biological, psychological, and
sociocultural factors
 Examples:
 Anorexia nervosa
 Anorexia bulimia
Copyright © 2022 Elsevier, Inc. All Rights Reserved. 64

Feeding and Eating Disorders

(2 of 13)
 Feeding and eating disorders in older
persons in long-term care facilities may
include:
 Fear of choking
 Sick feeling
 Depression
 Dislike for texture or taste of food

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 65

Feeding and Eating Disorders

(3 of 13)
 Anorexia Nervosa
 Occurs when a client has an intense fear of weight
gain and a distorted body image
 Is often a life-threatening condition.
 Three key features:
• A refusal to maintain minimal body weight within 15% of
an individual’s normal weight
• An intense fear of gaining weight
• A distorted body image of being “fat” or “ugly”

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 66

Copyright © 2022 Elsevier, Inc. All rights reserved. 22

 Feeding and Eating Disorders
(4 of 13)
 Anorexia Nervosa
 Has the highest mortality rate (6%) among all
psychiatric conditions.
 Behavioural and environmental influences, and
stressful events all increase risk.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 67

Feeding and Eating Disorders

(5 of 13)
 Signs and symptoms of anorexia nervosa:
 Obsession with food and weight
 Thoughts of looking fat, in spite of being bone-thin
 Depression
 Brittle nails, hair, dry and yellow skin, feeling cold
 Cessation of menstruation
 Lanugo on body (fine hair like newborn)

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 68

Feeding and Eating Disorders

(6 of 13)
 Signs and symptoms of anorexia nervosa:
 Cutting food into tiny pieces
 Refusal to eat in front of others
 Abusing laxatives and diuretics

 Effects on body includes damage to vital

organs, irregular heart rhythms or failure, and
calcium loss from bones.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 69

Copyright © 2022 Elsevier, Inc. All rights reserved. 23

 Feeding and Eating Disorders
(7 of 13)
 Bulimia nervosa:
 Occurs mainly in teenage girls and young women
 Is characterized by episodes of binge eating
followed by inappropriate methods of weight
control (e.g., purging):
• The client eats large amounts of food (up to 20 000
calories at a time)
• Then the body is purged (rid) of the food eaten to prevent
weight gain.
• Vomiting, laxatives, enemas, diuretics, fasting, and
intense exercise are some methods used to purge the
body of food.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 70

Feeding and Eating Disorders

(8 of 13)
 Bulimia nervosa
 Binge eating is not about hunger; it is usually a
response to depression, stress, or low self-
esteem.
 The cycle of overeating and purging becomes an
obsession.
• Foods binged on are usually ‘comfort foods’
 Most people with bulimia nervosa are of normal
weight
 Women with bulimia are usually high achievers
• Bingeing and purging are done in secret—the person
often denies condition.
Copyright © 2022 Elsevier, Inc. All Rights Reserved. 71

Feeding and Eating Disorders

(9 of 13)
 Signs and symptoms of bulimia nervosa:
 Eating uncontrollably
 Purging, strict dieting, fasting
 Vomiting or vomiting blood
 Using bathroom frequently after meals
 Preoccupation with weight
 Depression or mood swings
 Compulsive exercising

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 72

Copyright © 2022 Elsevier, Inc. All rights reserved. 24

 Feeding and Eating Disorders
(10 of 13)
 Signs and symptoms of bulimia nervosa:
 Excessive concern about shape and weight
 Heartburn, swollen glands, heartburn, bloating,
indigestion, constipation, irregular menstrual
periods, sore throat, poor dental health, bloodshot
eyes

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 73

Feeding and Eating Disorders

(11 of 13)
 Bulimia nervosa’s effects on the body:
 Erosion of tooth enamel
 Dental cavities; hot/cold sensitivities
 Swelling and soreness in salivary glands
 Stomach ulcer
 Rupture of stomach and esophagus
 Disruption in normal bowel function

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 74

Feeding and Eating Disorders

(12 of 13)
 Bulimia nervosa’s effects on the body:
 Electrolyte imbalance
 Dehydration
 Irregular heartbeat
 Increased risk for suicidal behaviour
 Decreased libido

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 75

Copyright © 2022 Elsevier, Inc. All rights reserved. 25

 Feeding and Eating Disorders
(13 of 13)
 Pica
 Defined as persistently eating substances without
nutritional value for a period of at least a month.
• Examples include clay, dirt, sand, stones, pebbles, hair,
feces, lead, laundry starch, vinyl gloves, plastic, pencil
erasers, ice, fingernails, paper, paint chips, coal, chalk,
wood, plaster, light bulbs, needles, string, cigarette butts,
wire, and burnt matches
 Some nutritional deficiencies may cause pica.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 76

Slide 76

Supporting Clients With Feeding

and Eating Disorders
 Be patient.
 Be compassionate.
 Be encouraging.
 Be nonjudgemental.
 Be positive.
 Prevent the client from eating nonfood
substances.
 Report any evidence of food refusal or
vomiting to supervisor.
Copyright © 2022 Elsevier, Inc. All Rights Reserved. 77

Obsessive–Compulsive and
Related Disorders (1 of 2)
 Characterized by recurrent obsessions and
compulsions that interfere with a person’s daily life
and relationships.
 An obsession is a persistent thought or desire.
 A compulsion is the uncontrollable urge to perform an act.
 If you observe repeated behaviours, report them to
your supervisor.
 The client performs these behaviours to help
relieve stress.
 Examples: repeatedly washing hands; checking
the same thing several times a day; repeating a
name, phrase, or tune
Copyright © 2022 Elsevier, Inc. All Rights Reserved. 78
Slide 78

Copyright © 2022 Elsevier, Inc. All rights reserved. 26

 Obsessive–Compulsive and
Related Disorders (2 of 2)
 Hoarding Disorder
 Defined as a persistent anxiety and distress in parting with
possessions or animals, regardless of their actual value.
 Behaviour can lead to health concerns
• Accumulation of dust, mould, garbage, excrement
• Cramped living conditions
• Strained relationships with significant others
 75% of clients who have a hoarding disorder also live with
an anxiety disorder.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 79

Slide 79

Other Obsessive–Compulsive
Disorders
 Body dysmorphic disorder
 Preoccupation with a perceived physical flaw in
one’s own mind that is not observable to others
 Trichotillomania disorder
 The need to pull out one’s hair
 Excoriation disorder
 Recurrent skin-picking
 Substance/medication-induced disorder
 Body-related repetitive behaviours triggered by
exposure to or intoxication from a substance or
medication
Copyright © 2022 Elsevier, Inc. All Rights Reserved. 80
Slide 80

Supporting a Client With

Obsessive–Compulsive and
Related Disorders (1 of 2)
 Show the client that you enjoy being with them.
 Listen to the client and be positive.
 Do not minimize the client’s thoughts and
behaviours.
 Encourage rest.
 Avoid “helping” behaviours around OCD:
 Rather than helping client avoid things that cause
anxiety, help them focus on the feelings behind the
behaviours.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 81

Copyright © 2022 Elsevier, Inc. All rights reserved. 27

 Supporting a Client With
Obsessive–Compulsive and
Related Disorders (2 of 2)
 Provide a safe, secure, stable environment.
 Follow the care plan.
 Encourage normal activities.
 Recognize accomplishments.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 82

Personality Disorders (1 of 6)
 Personality disorders are a group of disorders
that involve rigid and socially unacceptable
behaviours.
 People with personality disorders have problems
relating to others.
 They may be demanding, hostile, or manipulative.
 Personality disorders are not illnesses in a strict
sense, because they do not disrupt emotional,
intellectual, or perceptual functioning.
• They are associated with failure to reach one’s potential.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 83

Personality Disorders (2 of 6)
 According to the DSM-5, the main types of
personality disorders are as follows:
 Antisocial personality disorder
• Psychopaths and sociopaths—have little regard for moral
or legal standards of society
 Avoidant personality disorder
• Socially inhibited; extremely sensitive to criticism
 Borderline personality disorder
• Lack of identity; rapid mood changes; intense, unstable
interpersonal relationships; impulsiveness

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 84

Copyright © 2022 Elsevier, Inc. All rights reserved. 28

 Personality Disorders (3 of 6)
 Main types of personality disorders:
 Dependent personality disorder
• Extreme need of other people; person is unable to make
any decisions on his or her own
 Histrionic personality disorder
• Exaggerated, often inappropriate, displays of emotional
reaction in everyday behaviour
 Narcissistic personality disorder
• General lack of empathy for others; need to be admired
by others

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 85

Personality Disorders (4 of 6)
 Main types of personality disorders:
 Obsessive–compulsive personality disorder
• Perfectionism and inflexibility
 Paranoid personality disorder
• Distrust of others, including belief that others are
exploiting, harming, or trying to deceive them
 Schizoid personality disorder
• A very limited range of emotion, both in expressing and
experiencing emotions

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 86

Personality Disorders (5 of 6)
 Common signs and symptoms of personality
disorders:
 Self-centredness (“me-first” attitude)
 Lack of individual accountability
 Lack of empathy, perspective-taking
 Manipulative and exploitative behaviour
 Unhappiness, depression, other mood and anxiety
disorders

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 87

Copyright © 2022 Elsevier, Inc. All rights reserved. 29

 Personality Disorders (6 of 6)
 Common signs and symptoms of personality
disorders:
 Vulnerability to other mental disorders
 Distorted and superficial understanding of own
and others’ perceptions
 Trying to influence the external world to conform
to one’s own needs

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 88

Supporting Clients With

Personality Disorders (1 of 2)
 Accept clients in a caring, nonjudgemental way.
 Speak to your client in a factual and professional
manner.
 Provide care and support as specified in the client’s care
plan.
 Refrain from giving any client your phone number, e-mail
address, or information about your private life.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 89

Supporting Clients With

Personality Disorders (2 of 2)
 Do not accept gifts, money, or other items from your
client.
 Consult the client’s significant other for ways to
successfully deal with the client.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 90

Copyright © 2022 Elsevier, Inc. All rights reserved. 30

 Schizophrenia Spectrum
Disorders (1 of 4)
 These are severe, chronic, disabling brain
disorders.
 They affect 1% of Canadian population.
 Onset is between late teens and mid 30s.
 Characterized by delusions, hallucinations,
disorganized speech, grossly disorganized
behaviours, reduced or even dazed emotional
expressions.
 These disorders affect a person’s ability to
function in all aspects of life.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 91

Schizophrenia Spectrum
Disorders (2 of 4)
 Cause:
 Is thought to be the existence of a biochemical
imbalance.
 Some people may also have underlying genetic
vulnerabilities (which are sometimes triggered by
substance or drug abuse).

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 92

Schizophrenia Spectrum
Disorders (3 of 4)
 People with schizophrenia spectrum disorders
display one or more of the following:
 Psychosis (a state of severe mental impairment)
 Delusion (a false belief)
• Delusion of grandeur (an exaggerated belief of one’s
importance, wealth, power, or talents)
• Delusion of persecution (the false belief that one is being
mistreated, abused, or harassed)
 Hallucination (seeing, hearing, smelling, or feeling
something that is not real)
 Paranoia (extreme suspicion about a person or
situation)
Copyright © 2022 Elsevier, Inc. All Rights Reserved. 93

Copyright © 2022 Elsevier, Inc. All rights reserved. 31

 Schizophrenia Spectrum
Disorders (4 of 4)
 The client with schizophrenia has severe
mental impairment (psychosis):
 The client has problems relating to others.
 The client may have difficulty organizing thoughts.
 Responses are inappropriate.
 Communication is disturbed.
 The person may withdraw.
 Disorders of movement occur.
 Some persons have periods of remission.
• People with schizophrenia do not tend to be violent.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 94

Supporting Clients With

Schizophrenia Spectrum
Disorders
 Focus on one task or activity at a time.
 Be aware of your nonverbal communication.
 Do not argue with the client about the
delusion or hallucination not being real.
 Do not pretend the delusion or hallucination is
real.
 Use distractions to avoid disturbing the client.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 95

Self-Harm Disorders (1 of 2)
 Self-harm means inflicting pain on oneself to
deal with feelings of anxiety, depression,
numbness, loss of control, self anger, or to
regain emotional control over oneself.
 Act of self-harm may trigger the release of
neurochemicals in the body, adrenaline, dopamine
and endorphins.
 Client may feel temporary relief.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 96

Copyright © 2022 Elsevier, Inc. All rights reserved. 32

 Self-Harm Disorders (2 of 2)
 Warning signs of self-harm:
 Unexplainable wounds, cuts etc.
 Presence of unexplainable scars
 Person’s insistence that they’re ‘accident prone’
 Person covers up their body, even during warm
weather

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 97

Supporting Clients Who

Self-Harm
 Encourage person to have wounds treated.
 Focus on client’s concerns rather than the
self-harm.
 Encourage positive, healthy coping methods.
 Encourage open communication.
 Encourage seeking professional help.
 Encourage friends or significant others to
seek support from mental health professional
or support group.
Copyright © 2022 Elsevier, Inc. All Rights Reserved. 98

Sleep-Wake Disorders (1 of 3)
 Sleep is essential for normal, healthy
function.
 Sleep-wake disorders are conditions in which
repetitive disturbed sleep patterns lead to
distress and impairment in a person’s
daytime functioning.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 99

Copyright © 2022 Elsevier, Inc. All rights reserved. 33

 Sleep-Wake Disorders (2 of 3)
 Classified into 10 conditions:
• Insomnia (lack of sleep)—most common disorder
• Breathing-related sleep disorders
• Hypersomnolence disorder
• Narcolepsy
• Circadian-rhythm sleep–wake disorders
• Nightmare disorder
• NREM disorder
• REM disorder
• Willis-Ekbom disease
• Substance/medication-induced sleep disorder

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 100

Sleep-Wake Disorders (3 of 3)
 Supporting clients with sleep-wake disorders:
 Clients should avoid foods and medicines that
alter their chemical balance (e.g., caffeine).
 Observe if client has periods of not breathing, or
wakes up with a headache every morning.
 Encourage client to seek medical attention.
 Observe, report, and record:
• How long the client is sleeping during each stage of
sleep
• Make note of client’s use of prescription and
nonprescription drugs or alcohol

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 101

Substance-Related and Addictive

Disorders (1 of 4)
 The deliberate misuse of and inability to stop
the abuse of prescription medications, illegal
drugs, alcohol, or other substances.
 Many substances used are mood-altering
substances.
 Substance abuse or addiction occurs when a
person overuses or depends on alcohol,
illegal drugs, or prescription medication.
 The client’s physical and mental health are
affected, as is the welfare of others.
Copyright © 2022 Elsevier, Inc. All Rights Reserved. 102

Copyright © 2022 Elsevier, Inc. All rights reserved. 34

Substance-Related and Addictive
Disorders (2 of 4)
 Drug tolerance
 Occurs when a person needs larger amount of
substance for same effect.
 Drug withdrawal
 Person’s physical reaction when they stop taking
the substance.
 Detoxification
 Part of treatment for this disorder; should be done
with medical supervision

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 103

Substance-Related and Addictive

Disorders (3 of 4)
 Alcohol Use Disorder (AUD)
 Alcohol is abused more than any other substance.
 Signs and symptoms of alcohol abuse include
intoxication (drunkenness), memory impairment,
difficulty concentrating, tremors, and loss of
interest in family and friends.
 Women who drink during pregnancy can give birth
to a baby with fetal alcohol spectrum disorder.
 The DSM-5 divides alcohol use disorder into mild,
moderate, and severe subcategories.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 104

Substance-Related and Addictive

Disorders (4 of 4)
 Alcohol use disorder:
 For most people, exceeding two drinks a day can do
significant harm.
 Women who have more than 10 drinks a week and
men who have more than 15 drinks a week have
higher rates of alcohol-related problems.
 Older persons who live alone are at risk for alcohol
abuse.
 The main treatment is to avoid alcohol
 Support groups (e.g., Alcoholics Anonymous
[AA]) help people with drinking cessation.
Copyright © 2022 Elsevier, Inc. All Rights Reserved. 105
Slide 105

Copyright © 2022 Elsevier, Inc. All rights reserved. 35

 Supporting Clients With
Substance-Dependence
Disorders
 Report suspicions.
 You may smell alcohol or observe medications are
running out quickly.
 Avoid confrontation.
 Do not argue with client about abusing
substances.
 Never buy alcohol, drugs, or other
substances for clients.
 Report such requests to your supervisor.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 106

Suicidal Behaviour Disorder

(1 of 5)
 A disorder in which the person has recurrent
thoughts or a preoccupation with ending their
own life.
 Attempted suicide is a sign of a serious mental
health issue, and professional care is needed.
 Any person talking about suicide should be taken
seriously.
 Suicide is a common cause of death in males and
females from adolescence to middle age.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 107

Suicidal Behaviour Disorder

(2 of 5)
 Risk factors that may lead to suicidal intent or
behaviour:
 Mental health disorders, especially depression,
bipolar disorder, or schizophrenia
 A history of abuse
 A family history of suicide
 The suicide of a friend
 A prior suicide attempt
 A major crisis
 Pressure to succeed

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 108

Copyright © 2022 Elsevier, Inc. All rights reserved. 36

 Suicidal Behaviour Disorder
(3 of 5)
 Risk factors that may lead to suicidal intent or
behaviour:
 Isolation
 Early losses in life
 Sexual identity issues
 Feelings of deep hopelessness and helplessness
 Recent diagnosis of a life-threatening condition
 Substance abuse

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 109

Suicidal Behaviour Disorder

(4 of 5)
 Additional risk factors for older persons:
 Personality factors
 Medical illness, such as chronic pain; sensory
impairment
 Negative life events, such as loss or financial
difficulties
 Functional impairment, such as a loss of
independence or problems performing activities of
daily living (ADLs)
• See textbook box: Focus On Older Persons: Suicide

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 110

Slide 110

Suicidal Behaviour Disorder

(5 of 5)
 Supporting clients who have suicidal intent:
 Always take a client seriously if they are talking
about suicide.
 Report to your supervisor immediately.
 Do not leave the client alone.
 Encourage the client to talk.
 Do not minimize the client’s concerns.
 Stay with the client until help arrives.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 111

Slide 111

Copyright © 2022 Elsevier, Inc. All rights reserved. 37